Role of spiral CT scan and endoscopic ultrasonography in assessing operability of peri-ampullary tumors

ABSTRACT

Pancreatic cancer is associated with an extremely poor prognosis with less than 5% of patients surviving 5 years after the diagnosis. Current preoperative staging modalities include various cross sectional imaging techniques. including spiral CT and endoscopic ultrasound [EUS]. This prospective study aimed at demonstrating the role of spiral CT and endoscopic ultrasonography in early diagnosis staging and assessment of operability of periampullary tumors. Sixty-two patients with periampullary tumors were included in this study. All cases were subjected to abdominal ultrasound. Spiral CT. ERCP. EUS and operative interference. Surgical findings were considered the gold standard for assessing the sensitivity of spiral CT and EUS in diagnosing, staging arid estimating resectability of periampullary tumors. Endoscopic Ultrasonography was very sensitive in detecting periampullary masses [93.5%] especially masses smaller than 20mm while the sensitivity of spiral CT was 71%. EUS was also very sensitive in detecting ampullary masses [100%] in contrast to spiral CT chat missed the diagnosis of the 14 ampullary masses found in our work. EUS was more sensitive than Spiral CT in detecting malignant vascular invasion [95% versus 75%] while it was slightly less specific than spiral CT in that context [74 versus 80%]. The predictive value of spiral CT was 60% for tumor resectability while it was 100% for tumor unresectability. The predictive value of EUS was 735% for tumor resectability while it was 96.4% for tumor unresectability. When combining both techniques the predictive value for tumor resectability was 65% while it was 100% for tumor unresectability. No complications were encountered in both techniques. We concluded that EUS is more sensitive than spiral CT in detection and staging of periampullary masses. Also. the non-invasive spiral CT and the minimally invasive EUS are very valuable tools in predicting uresectability of periampullary masses while EUS is slightly more valuable in detecting tumor resectability